Abstract
Background
Salivary pepsin measurement has been reported to be useful for diagnosing gastroesophageal reflux disease (GERD). This study aimed to clarify the usefulness of salivary pepsin measurement in patients with proton pump inhibitor (PPI)-refractory GERD symptoms without erosive esophagitis.
Methods
One hundred and two patients were included. Over seven days after terminating PPI treatment, all patients underwent a 24-h pH-impedance test and salivary pepsin measurement. In patients whose main symptoms included laryngopharyngeal symptoms, a hypopharyngeal multichannel intraluminal impedance (HMII) test was performed, whereas in other patients, a conventional combined multichannel intraluminal impedance-pH (MII-pH) test was performed. In the HMII tests, patients were divided into abnormal proximal exposure (APE) and non-APE groups. Salivary pepsin concentrations were compared according to acid exposure time (AET) values and were also compared between the APE and non-APE groups.
Results
The median salivary pepsin concentration in patients with AET > 6% was significantly higher than that in patients with AET ≤ 6% (345.0 [170.0–469.3] ng/mL vs. 120.0 [97.0–290.1] ng/mL, p < 0.01). The sensitivity, specificity, positive predictive value, and negative predictive value of a positive test (> 109 ng/mL) to diagnose patients with AET > 6% were 75.0%, 51.3%, 32.1%, and 86.9%, respectively. There was no significant difference between concentrations in the APE group and concentrations in the non-APE group.
Conclusions
In patients with PPI-refractory nonerosive reflux disease, salivary pepsin measurement may help diagnose patients who have conclusive evidence of reflux, whereas it is not adequate for identifying patients with APE.
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Abbreviations
- GERD:
-
Gastroesophageal reflux disease
- NERD:
-
Nonerosive reflux disease
- FH:
-
Functional heartburn
- RH:
-
Reflux hypersensitivity
- AET:
-
Acid exposure time
- MII-pH:
-
Combined multichannel intraluminal impedance-pH
- HMII:
-
Hypopharyngeal multichannel intraluminal impedance
- PPI:
-
Proton pump inhibitor
- LPR:
-
Laryngopharyngeal reflux
- APE:
-
Abnormal proximal exposure
- FCR:
-
Full column reflux
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Acknowledgements
We thank Atsuko Kikuchi and Mai Fujie for their help on 24-h pH impedance test.
Funding
This work was supported by JSPS KAKENHI Grant No. 18K09367.
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TM and TS designed the study, conducted the experiment, collected data, analyzed and interpreted data, and wrote the manuscript. TM, AM, TS, and TH designed the study, analyzed, and interpreted data, assisted in writing the manuscript. YS, SK, HI, KI, KO, NA, DM, and TN assisted in conducting the experiment and collecting data. TO, YO, and NK assisted in interpreting data and writing the manuscript. All authors approved the final version of the manuscript.
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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or substitute for it was obtained from all patients for being included in the study.
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The authors indicated no potential conflicts of interest.
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Matsumura, T., Arai, M., Suzuki, T. et al. Clinical utility of salivary pepsin measurement in patients with proton pump inhibitor-refractory gastroesophageal reflux disease symptoms: a prospective comparative study. Esophagus 17, 339–347 (2020). https://doi.org/10.1007/s10388-020-00714-z
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DOI: https://doi.org/10.1007/s10388-020-00714-z